Osteomalacia

Ensuring adequate sunlight exposure and dietary intake of fortified foods containing vitamin D, calcium, and phosphorus may help avoid osteomalacia.[43]Holick MF. Sunlight, UV-radiation, vitamin D and skin cancer: how much sunlight do we need? Adv Exp Med Biol. 2008;624:1-15. http://www.ncbi.nlm.nih.gov/pubmed/18348443?tool=bestpractice.com

Nutritional rickets is an under-recognized global health problem and can be prevented with adequate vitamin D and calcium intake, as well as vitamin D fortification of foods.[35]Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. 2016 Feb;101(2):394-415. https://academic.oup.com/jcem/article/101/2/394/2810292 http://www.ncbi.nlm.nih.gov/pubmed/26745253?tool=bestpractice.com Maintenance dosing of vitamin D in children and adults ages 1-70 years should be 600 international units (IU) daily; adults ages ≥70 years should get 800 IU of vitamin D daily.[44]Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, DC. The National Academies Press. 2011 [internet publication]. https://www.nap.edu/catalog/13050/dietary-reference-intakes-for-calcium-and-vitamin-d Some experts recommend up to 2000 IU vitamin D daily for adults and 1000 IU daily for children for optimal health.[45]Holick MF. Vitamin D: a D-lightful solution for health. J Investig Med. 2011;59:872-880. http://www.ncbi.nlm.nih.gov/pubmed/21415774?tool=bestpractice.com

The National Osteoporosis Foundation recommends that women aged 50 years and younger should get 1000 mg/day of calcium in the diet or as a supplement, and women aged 51 years and older should get 1200 mg/day.[46]National Osteoporosis Foundation. Get the facts on calcium and vitamin D. http://www.nof.org/ (last accessed 9 May 2016). https://www.nof.org/patients/treatment/calciumvitamin-d/get-the-facts-on-calcium-and-vitamin-d Men ≤70 years should get 1000 mg/day of calcium; men aged 71 years or more should get 1200 mg/day.[46]National Osteoporosis Foundation. Get the facts on calcium and vitamin D. http://www.nof.org/ (last accessed 9 May 2016). https://www.nof.org/patients/treatment/calciumvitamin-d/get-the-facts-on-calcium-and-vitamin-d

Vitamin D levels should be measured in all patients being assessed for secondary causes of osteoporosis, as osteomalacia and osteoporosis are indistinguishable on dual-energy x-ray absorptiometry scan.